Stroke Pathophysiology, Diagnosis, and Management.pdf

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Stroke
Stroke
Pathophysiology, Diagnosis, and Management
SIXTH EDITION
James C. Grotta, MD
Director, Stroke Research
Clinical Innovation and Research Institute;
Director, Mobile Stroke Unit Consortium
Memorial Hermann Hospital-Texas Medical Center
Houston, Texas, USA
A. David Mendelow, MB BCh, PhD
William Leech Professor of Neurosurgery
Newcastle University
Consultant Neurosurgeon
Department of Neurosurgery
Royal Victoria Infirmary
Newcastle upon Tyne, UK
Gregory W. Albers, MD
Professor of Neurology and Neurological Sciences
Director, Stanford Stroke Center
Stanford School of Medicine
Stanford, CA, USA
Ralph L. Sacco, MD, MS
Professor and Olemberg Chair of Neurology;
Miller Professor of Neurology, Public Health Sciences,
Human Genetics, and Neurosurgery;
Executive Director, McKnight Brain Institute;
Chief of Neurology, Jackson Memorial Hospital
Miller School of Medicine
University of Miami
Miami, FL, USA
Joseph P. Broderick, MD
Professor, Department of Neurology and
Rehabilitation Medicine;
Director, University of Cincinnati
Neuroscience Institute
Cincinnati, OH, USA
Lawrence K.S. Wong, MD
Mok Hing Yiu Professor of Medicine
Chief of Neurology
Department of Medicine and Therapeutics
The Chinese University of Hongkong
Prince of Wales Hospital
Shatin, Hong Kong Special Administrative Region
China
Scott E. Kasner, MD
Professor, Department of Neurology
Perelman School of Medicine
University of Pennsylvania;
Director, Comprehensive Stroke Center
University of Pennsylvania Health System
Philadelphia, PA, USA
Eng H. Lo, PhD
Professor of Neurology and Radiology
Massachusetts General Hospital
Harvard Medical School
Boston, MA, USA
Copyright © 2016, Elsevier Inc. All rights reserved.
First edition 1986
Second edition 1992
Third edition 1998
Fourth edition 2004
Fifth edition 2011
Sixth edition 2016
© Martin M. Brown retains copyright to his original figures in chapter 22 (Figures 22-3, 22-12 and 22-14)
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Notices
Knowledge and best practice in this field are constantly changing. As new research and experience
broaden our understanding, changes in research methods, professional practices, or medical
treatment may become necessary.
Practitioners and researchers must always rely on their own experience and knowledge in
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instructions, or ideas contained in the material herein.
ISBN: 978-0-323-29544-4
INK: 978-0-323-32806-7
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1
Foreword to the Sixth Edition
This, the sixth edition of
Stroke,
has passed from the hands of
the last of the original four editors to a distinguished and
experienced group now numbering eight. The chapter numbers
have also increased from the original 61 to 76. The content of
these chapters is altered by the very advances the first-edition
authors had hoped for.
The few involved in the brief hallway discussion that led
to the first edition could not foresee – but certainly hoped for
– the expansion in the scope of interest in the field. In 1986
it was still struggling for independence as a justifiable multi-
disciplinary specialty. Considerable latitude existed for man-
agement using experience-based bias, heavy reliance on
clinical semiology, and for some an uncertainty of the value
of imaging. Few clinicians focused disproportionately on
stroke, and most of them were in major centers. Many outside
the field still thought of stroke as a bed-occupying distraction
lacking therapy, suitable for early discharge. “It’s just a stroke”
was a common observation.
Contrast that with today, where stroke is the main in-
patient service for the clinical neurosciences – for many also
including a separate neuro-intensive care unit. Success in very
early therapy has changed the attitude of patients toward the
disease. Career efforts are made from many disciplines, sub-
specialty ACGME certification exists, heavy reliance is placed
on imaging, emergency management is focused on the very
earliest intervention, sophisticated statistical models dictate
plans for clinical trials, and we are expected to “Get with the
Guidelines”.
Along the way semiology has properly given way to patho-
physiology as revealed by imaging, biomarkers, and interven-
tion – both physical and medical. While there is an asymptote
of treatment effect in sight, a resurgence of interest in semiol-
ogy is in the offing. Given the current opportunities to under-
stand brain reorganization, ways will eventually be found to
ameliorate those syndromes that occur despite the best efforts
at their prevention. This emeritus editor sees a bright future
ahead.
J. P. Mohr, MD, MS
Daniel Sciarra Professor of Neurology
Department of Neurology
Columbia University
New York, NY, USA
viii

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